To address the NCD epidemic, the Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), as part of the National Rural Health Mission in Year 2010. In addition, the Tamil Nadu Health Systems Project (‘TNHSP’) is running a NCD program. In both these Central and State Government programs the screening for NCDs is opportunistic (performed only if the person comes to the PHC) resulting in missed cases. Despite providing services free of cost, only a few of persons diagnosed with NCDs consistently seek treatment and collect medications at PHCs due to lack of awareness and want of motivation. Our goal is to develop a mobile technology enabled, scalable, cost-effective rural PPP model as an extension of the current Government programs for case finding, care linkage and treatment compliance for diabetes and other NCDs within existing rural healthcare infrastructure.
The Tamil Nadu state government’s Tamil Nadu Health Systems Project (‘TNHSP’), a World Bank funded project is running a NCD program in the target area. Under TNHSP, screening is opportunistic (performed only if the person comes to the PHC) resulting in many missed cases. Moreover, all treatment services are provided only at the PHC thus requiring the patient to maintain frequent contact with the PHC. Despite providing services free of cost, only a few of persons diagnosed with NCDs consistently seek treatment at the PHCs or have adequate control of their chronic disease due to lack of awareness, self-management skills and lifestyle intervention. To address these limitations, we implemented the PPP model, the Rural m-Health NCD Prevention Program for mass screening for NCDs at home/village level, connect them to treatment available at the PHCs and provide lifestyle intervention, and to empower underserved rural population with self-management skills.
Availability of trained medical staff in the target area is a major challenge. We were able to mitigate this by ‘task shifting’, where in front-line, CHWs were recruited from the local community, trained, and delegated tasks traditionally performed by fully qualified medical personal. The risk with this model is the quality of data collected and intervention provided by CHWs. Currently, we are able to show that quality of health services delivered by CHWs can be consistent with the use of mobile technology, and by the continued support, supervision and training. With the use of mobile technology, we are able to track CHWs efficiency and quality of their data collection.
Successful NCD management requires being in touch with the patients continuously and motivating them. Performing these tasks at the community level is a major challenge. We address this challenge by (1) increasing overall awareness in community and addressing community specific barriers to care; (2) involving family members, particularly women in the family. The women's role in preparing and serving food and being responsible for the overall wellbeing of the family in the traditional rural households proves useful in the implementation of this program; (3) Regular home visits by CHWs helps build relationship with the participants, increase awareness, address personal barriers and motivate; (4) Use of mobile technology to educate and connect with educational and motivational SMS/IVR is a valuable addition.